Abstract 12637: Regional Differences in Management and Outcomes of Unstable Angina/Non-ST-Elevation Myocardial Infarction in the United States
Background: Regional differences across the United States in the treatment and outcomes of patients with unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) remain poorly understood.
Objectives: To examine regional variation in the management (early invasive versus initial conservative strategy) and outcomes (in-hospital mortality, length of stay and total hospital cost) of patients with UA/NSTEMI across the United States.
Methods: We used the 2003-2010 Nationwide Inpatient Sample databases to identify all patients aged ≥40 years hospitalized with UA/NSTEMI (ICD-9-CM codes 411.1 and 410.7x). Patients were divided into 4 groups according to region - Northeast, Midwest, South and West. Early invasive strategy was defined as coronary angiography within 48 hours of admission, with or without revascularization. Multivariable logistic regression was used to identify differences in treatment strategies and outcomes between the 4 regions.
Results: From 2003-2010, among 3,563,012 patients ≥40 years of age with UA/NSTEMI, 789,468 (22.2%) were hospitalized in the Northeast, 810,888 (22.8%) in the Midwest, 1,397,651 (39.2%) in the South and 565,005 (15.9%) in the West. When adjusted for demographics, hospital characteristics, co-morbidities and initial presentation (UA or NSTEMI), compared to the Northeast, patients in the Midwest, West and South were more likely to be managed using the early invasive strategy (Midwest OR 1.35, 95% CI 1.33-1.36; South OR 1.24, 95% CI 1.23-1.25; West OR 1.38, 95% CI 1.37-1.40). In-hospital mortality was highest in the Northeast (4.7% versus 3.9% in the Midwest, 4.2% in the South and 3.9% in the West; p≤0.001). After adjusting for confounding variables, in-hospital mortality remained lower in the Midwest (OR 0.95, 95% CI 0.93-0.7), South (OR 0.94, 95% CI 0.92-0.96) and West (OR 0.96, 95% CI 0.04-0.98), as compared to the Northeast. Patients in the West had the shortest average length of stay (4.6 ± 5.7 days) and accrued the highest unadjusted total hospital cost ($21,398 ± 25,417).
Conclusion: Patients with UA/NSTEMI in the Midwest, South and West are more likely to be managed using the early invasive strategy and have a lower in-hospital mortality, as compared to those in the Northeast.
- © 2013 by American Heart Association, Inc.